Pregnancy as a cardiac stress model

Abstract

Cardiac hypertrophy occurs during pregnancyas aconsequence ofboth volume overload and hormonal changes. Both pregnancy- and exerciseinduced cardiac hypertrophy are generally thought to besimilar and physiological. Despite the fact that there are shared transcriptional responses in both formsof cardiac adaptation, pregnancy resultsinadistinct signatureofgene expressioninthe heart.Insome cases, however, pregnancy can induce adverse cardiac events in previously healthy women without any known cardiovascular disease. Peripartum cardiomyopathy is the leading cause of non-obstetric mortality during pregnancy. To understand how pregnancy can cause heart disease, it is first important to understand cardiacadaptation during normal pregnancy.This review providesanoverviewofthecardiac consequencesofpregnancy,including haemodynamic, functional, structural, and morphological adaptations, aswellas molecular phenotypes. Inaddition, this review describesthe signalling pathways responsible for pregnancy-induced cardiac hypertrophy and angiogenesis. We also compare and contrast cardiac adaptation in response to disease, exercise, and pregnancy. The comparisons of these settings of cardiac hypertrophy provide insight into pregnancy-associated cardiac adaptation.